A health record integrated clinical decision support system to support prescriptions of pharmaceutical drugs in patients with reduced renal function: Design, development and proof of concept

This is the review article by T. Shemeikka, et al.,(2015) titled “A health record integrated clinical decision support system to support prescriptions of pharmaceutical drugs in patients with reduced renal function: Design, development and proof of concept”.

Background

Renal Impairment is very common in general population, and is associated with enhance in morbidity and mortality. Inappropriate use of drugs in the patient with renal impairment may cause adverse events, unnecessary hospital admissions, prolonged hospital stays, increased costs and deaths. The aim of this study was to introduce a (CDS) in Janus toolbar with evidence based recommendations on drugs and renal function that would cover the majority of the substance used in drugs on Swedish market.

Objective

The objective of this study was to build up and validate proof of concept for a Clinical Decision Support System (CDSS) to support prescriptions of pharmaceutical drugs in patients with reduced renal function, integrated in an electronic health record system (EHR) used in both hospitals and primary care.

Methods

Renbasewhich is decision support database for drug dosages in the renal failure. It is based on scientific publications and clinical studies. The Janus toolbar is a CDSS which uses Renbase was used as pilot units to test the system; one geriatric clinic, one internal medicine admission ward and two outpatient healthcare centers. This CDSSwas evaluated with a questionnaire focusing on the usefulness of the CDSS in the users.

Results

In the evaluation questionnaire, the overall usefulness of the CDSS was rated 4.4 out of 6. The mean global assessment of the system has been rated 4.7. The decision support system is considered to increase the physicians’ attention on patients with impaired renal function, provides a better understanding of dosing for these patients and is seen as a support in the daily clinical work. The physicians strongly agreed that the CDSS helps to increase their knowledge of dosing drugs for this patient group, and to start and discontinue drug treatment.

Discussion

The main limitation of this study was to gain correct information on how often each clinician used the system. The number of times the kidney information button in the toolbar was activated was monitored but it was difficult to evaluate how many different patients were controlled since the toolbar could be used several times during the same patient meeting. The study has given us new knowledge in the use of the log information when evaluating the use of a CDSS

Comments

A real time CDSS to support drug prescription for renal impairment in outpatient and hospital settings is important to clinicians. It has the prospective to improve quality of drug prescribing by increasing the awareness on patients with renal insufficiency and the knowledge of their drug dosing.